农村公共卫生投融资机制存在的问题及对策

当前,农村公共卫生投融资规模不能适应农村居民的卫生服务需要,投融资结构不合理,致使投融资效果不佳,不利于农村卫生事业的发展。为此,需要从四个方面改革农村公共卫生投融资机制:一是要建立健全国家财政投资保障制度,发挥财政在农村公共卫生投资中的主体作用;二是要改革运行模式,拓宽融资渠道;三是要改善投资结构,优化资源配置;四是要创新管理体制,提高农村公共卫生服务能力。     

Elderly first admissions to psychiatric institutions: Findings of a nationwide Danish cohort

A nationwide cohort of first-time admitted patients aged 65 years or more to Danish psychiatric institutions was followed over a 10-year period in the Danish psychiatric register. The annual incidence rate was 3.4 males and 3.9 females per 1000. Females were more likely to get an age-related diagnosis, had more admissions and longer stays than males. 62.6% of the males and 53.9% of the females died as patients or were discharged within one year and not readmitted. More frequently this short-term group had a non-psychotic disorder. 21.9% of the males and 27.2% of the females became long-stay patients and were characterized by organic disorders. 1.9% of the males and 3.2% of the females became revolving-door patients and were characterized by manic depressive psychoses and organic disorders. In total the annual incidence rate of ‘heavy users’ was estimated to be 0.81 males and 1.14 females per 1000.     

医患沟通——优化医疗服务的新课题

市场经济环境中,医患双方都增强了许多内在需要,传统医学模式下的医疗卫生服务方式难以适应这种需要的变化.良好的医患沟通,能反映现代医学模式本质特征并符合国情,能较好地满足新环境下医患双方的需要,也是对传统医学模式下的医疗服务方式的优化,具有现实的价值和深远的意义.     

Evaluation of the Crithidia assay to distinguish between auto-immune chronic active hepatitis and systemic lupus erythematosus

The aim of this study was to determine if the Crithidia luciliae assay for auto-antibodies to double-stranded DNA, often positive in systemic lupus erythematosus, is always negative in auto-immune chronic active hepatitis (CAH) as has recently been suggested. Twenty-five patients were identified as having auto-immune CAH. Mean duration of follow-up was 10.5 years. Antinuclear antibodies were detected in 92%, smooth muscle antibodies in 76% and antimitochondrial antibodies in 16%. Antibodies to double-stranded DNA were detected by the Crithidia assay in four patients (16%). Two of these patients had positive tests on only one occasion and no features of systemic lupus erythematosus. In the other two the assay was persistently positive. During follow-up both developed arthritis and serositis but the liver lesion remained the dominant clinical feature. It was concluded that there is significant serological overlap between auto-immune CAH and systemic lupus erythematosus making the Crithidia assay unreliable in distinguishing between them.     

对住院病人医疗服务评价及需求的调查分析

目的 考查医院现有服务结构的合理性和病人对医疗服务的需求。方法 对作者所在医院19个临床科室年龄15岁以上的130名病人进行问卷调查,医疗服务评价内容包括:(1)医院饮食、卫生状况;(2)收费合理性;(3)收费透明度;(4)病人总体满意度。医疗服务需求包括:(1)出院后服务;(2)药物类型;(4)病房类型(4)收费透明度;(5)知情选择。结果(1)医疗服务评价:87.4%病人对卫生状况满意,513%病人认为收费合理,6．7%病人认为收费不合理;37.2%病人认为收费透明度高,8.3%病人认为收费透明度低,大部分病人希望住院部每3~5 d给一次费用报告单;82．8%病人对医疗服务感到满意。表明医疗服务的综合质量虽然得到了病人的普遍赞同,但在饮食服务、收费透明度和收费合理性方面仍有待提高。(2)医疗服务需求:91.3%病人希望出院后一定时间内可免费看门诊或叶通过电话向主管医生咨询有关疾病防治、保健等问题;73．8%病人希望用合资企业生产的或国产药物,26．2%病人喜欢用进口药,仅11.3%病人认为药物越贵治疗效果越好;喜欢住50-70元双人间的病人占40．8%,愿意住30-50元多人间和90~120元单人间的病人比例分别为359%、23.3%;调查人群入住单人间、双人间与多人间的比例为2:39:59,病人需求的理想病房结构是36:41:23．矛盾突出在现在的人间设置得     

青岛市居民就诊单位选择影响因素的多项式Logistic回归分析

①目的研究影响青岛市城乡居民选择就诊单位的因素。②方法采用多项式Logistic回归分析法，分析影响青岛市城乡居民选择就诊单位的主要因素。③结果影响市区病人选择就诊单位的主要因素是医疗保健制度和居民健康状况．农村病人的主要影响因素是家庭收入、健康状况和受教育程度。④结论居民就诊单位选择受多种因素的影响，建议加快医疗保健制度的改革．完善医疗保健制度。     

影响医疗服务满意度评价因素初步分析

目的　分析病人对医疗服务满意度评价的影响因素。方法　采用随机抽样的方法 ,对 5 10人进行了问卷抽样调查。结果　影响病人对医院服务满意度评价的因素依次为 :医生的医疗技术不高占 39 5 % ,医院服务态度不好占 2 2 8% ,医药费太高占 2 1 1% ,看病排队占 16 6 %。病人对医生服务态度好的评价标准依次是 :耐心倾听病人诉说占 6 1 6 % ,责任心强、看病认真占 30 6 % ,对病人热情、主动占 7 8%。结论　可靠的医疗技术和良好的服务态度是影响病人对医院服务满意度评价的最重要的两个因素。耐心倾听病人诉说是影响医生服务态度的最重要因素。病人的年龄、职业、文化、经济收入等因素对医疗服务的满意度评价均有作用     

搞好护患关系 提高护理服务满意度

近年来随着环境污染的日益加重,恶性肿瘤发病率逐年上升,从2000年至2004年我科收治病人1 632例,其中初治者648例,复治者有984例。复治病人的增加与医学科学不断发展,医疗护理技术水平不断提高,病人生存期不断延长有关。随着患者维权意识的增强,临床上常出现一些医疗纠纷,往往许多纠纷的切入点是护理不到位。笔者从事肿瘤内科临床护理工作多年,得出如下经验:加强护患关系是减少护患纠纷、提高社会效益及提高中晚期肿瘤患者生存质量的非常重要的环节。古人云“知己知彼,百战百胜”,如何搞好护患关系,是护理工作的重点。1对护理服务对象的评估…     

Prevalence, morbidity and service need among South Asian and white adults with intellectual disability in Leicestershire, UK

Background Previous reports have suggested that South Asian and white UK populations have different prevalences of intellectual disability (ID), related psychological morbidity and service use. The aim of the present study was to compare these rates among South Asian and white adults in Leicestershire, UK. Method This cross‐sectional study is comprised of two parts. The analysis of prevalence is based on data from all South Asian and white adults known to the Leicestershire Learning Disabilities Register in 1991, with population denominators being drawn from the 1991 census. The other analyses use data collected from the most recent semi‐structured home interviews, carried out between 1987 and 1998, with 206 South Asian and 2334 white adults. Results The prevalence of ID in adults in Leicestershire is 3.20 per 1000 in South Asians and 3.62 per 1000 in whites. Among adults with ID, South Asians have similar prevalences of disabilities to whites and significantly lower skill levels. South Asians show similar levels of psychological morbidity, but make significantly lower use than whites of psychiatric services, residential care and respite care. South Asians use community services as extensively as whites, but feel that they have a substantially greater unmet need, especially with regard to social services. Conclusion South Asian and white populations have similar prevalences of ID and related psychological morbidity. Culturally appropriate services for South Asian adults may need to focus on skill development and community care.     

电针及生物活性物质对大鼠多形核细胞杀菌功能的影响

用改良的四氮唑硝基蓝（ＮＢＴ）还原法观察了电针以及生物活性物质（ＢＡＳ）包括５－羟色胺（５－ＨＴ）、血管活性肠肽（ＶＩＰ）、生长抑素（ＳＯＭ）和Ｐ物质（ＳＰ）对大鼠多形核白细胞（ＰＭＮ）杀菌功能的影响。结果表明：电针及ＢＡＳ均能增强大鼠ＰＭＮ的杀菌功能（Ｐ＜０．０１）；ＢＡＳ对大鼠ＰＭＮ的杀菌功能具有双向调节效应。纳洛酮可阻抑电针对ＰＭＮ杀菌功能的提高（Ｐ＞０．０５）；可被ＢＡＳ所翻转。电针的镇痛效应和ＮＢＴ阳性细胞提高效应之间存在着明显的正相关（Ｐ＜０．０１）。